Understanding and Transforming Trauma SMART 2016€¦ · Strategies for Managing Abuse Related Trauma Understanding and Transforming Trauma SMART Foundation and Strategies 2020 Ceduna

17/01/2020

1© Australian Childhood Foundation 2016

SMARTStrategies for Managing Abuse Related Trauma

Understanding and Transforming Trauma

SMART Foundation and Strategies 2020

Ceduna

Trainer: Carolyn Grace


The Australian Childhood Foundation

acknowledges Aboriginal and Torres Strait Islander people as the traditional custodians of this land

and we pay our respect to their Elders past, present

and future.


SMART Learning Pathway

▪ SMART Online Training – 6 hours

▪ SMART – 2 hour training – facilitated by a local SMART Trainer

▪ SMART – Day 1 – Foundation (includes specialist packages ie Early Years, Refugees, Adolescents, Working with Aboriginal communites)

▪ SMART – Day 2 – Strategies (for the above as well)

▪ SMART Train the Trainer program – 3 days

▪ Graduate Certificate in Developmental Trauma (24 F:F days, online components available as well in 2020)

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childhood.org.au

Introductions

• Name

• Role

What are you passionate about in the work you are doing and in the work you are doing

with children and young people who have experienced trauma?

https://innovativeresources.org/resources/card-sets/symbols/

Image source: Shutterstock


Session outline

▪ examine brain development in children

▪ define complex abuse related trauma

▪ understand the impact of trauma on children’s and young people’s development and functioning

▪ develop strategies for working with traumatised children

▪ discuss whole school or service approaches to supporting traumatised children


Key learning outcomes

▪ develop an enhanced understanding of complex abuse related trauma, with a particular focus on its effects on brain functioning.

▪ apply a framework for assessing the impact of complex abuse related trauma on children and young people.

▪ build on practice skills to apply key models of intervention which promote recovery for children in an education setting.

https://innovativeresources.org/resources/card-sets/symbols/

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Principles guiding this workshop

▪ we assume a knowledge of child abuse and state mandatory reporting requirements

▪ discussion & questions only enhance the session

▪ abuse related trauma covers the impact of all forms of child abuse, including sexual abuse, physical abuse, emotional abuse, family violence and neglect.

▪ your emotional safety is paramountImage source: istock


Introducing the SMART Practice Framework

▪ Predictable▪ Responsive ▪ Attuned ▪ Connecting ▪ Translating ▪ Involving ▪ Calming ▪ Engaging


Safety & relationships are key…

It is important to remember that safety – feeling and being safe and having safe, connected and attuned relationships are key to supporting a child or young person who has experienced trauma.

These primary relationships contribute to:

▪ stored internal working models of primary relationships recorded in the right hemisphere

▪ the perception of emotion in self and others, enabling empathy and humour.

▪ healing from trauma Image source: ©ACF2020

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Trauma

©Australian Childhood Foundation 2018

How would you define trauma?

What have you noticed with your students?

Simple

Complex

Developmental

Intergenerational

Transgenerational

Historical


Defining trauma

Any single, ongoing or cumulative experience which:

▪ is a response to a perceived threat

▪ overwhelms our capacity to cope

▪ feels/is outside our control

▪ evokes a physiological and psychological set of responses based on fear or avoidance


Complex relational trauma

▪ most often involves multiple incidents over an extended period of time

▪ is blaming or stigmatising of the victim

▪ based in relationship and associated with shame

▪ is an isolating experience due to the interpersonal element, often underpinned by intentionality

▪ induces a sense of disconnection from others and their support

Image source: istock

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Developmental trauma

Occurs when the foetus in utero, baby, child or adolescent experiences trauma, from abuse and neglect during these

stages of development

▪ Children and young people are very vulnerable to the effects of trauma because of their brain’s developmental immaturity - their brains are malleable, so the impact of trauma is faster to manifest and leaves deeper tracks of damage

▪ Children’s development can slow down or be impaired often leading to children experiencing splintered development



▪ An understanding of child development is

pivotal in recognising and distinguishing the

impact of trauma

▪ Babies, children & young people who

experience chronic traumatisation often

experience developmental delays

across a broad spectrum including:

▪ Cognitive skills

▪ Language skills

▪ Motor skills

▪ Social skills

Understanding the developing child and the impact

of trauma

▪ An understanding of normative brain

development gives us a point of

comparison for considering the impact of

trauma

▪ A neurobiological understanding of trauma

offers explanations about the way that it

affects a child/young person

Development Neurobiology

Image source: https://unsplash.com


Trauma impacts

Trauma can impact all elements of children’s development: brain, body,

memory, learning, behaviour, emotions, relationships.

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Neuronal connections

▪ Neurons – cells in our brain interact and communicate with other neurons

▪ The neural system has the ability for one neuron to communicate with up to 10,000 other neurons

▪ The newborn brain has approximately 100 billion neurons

What builds our neuronal connections?

Image source: ©ACF 2020



Neuronal connections

What implications

might this have

for classroom

practice?


Neuroplasticity – hope for healing

Image source: http://highexistence.com/its-all-in-your-head-how-to-take-advantage-of-neuroplasticity/

https://www.youtube.com/watch?v=ELpfYCZa87g

Neuroplasticity refers to the brain’s capacity to:

▪ Grow new nerve cells

▪ Strengthen connections between nerve cells

▪ Sprout new connections between different cells

https://www.youtube.com/watch?v=ELpfYCZa87g

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The brain in culture

The cultural context of our experiences with other

people influence the

brain’s development

Sensory data is interpreted according to the parameters

of the surrounding culture long before cognitive

understanding of that culture

Culture organises interpersonal

relationships and promotes

neuronal connections

that support a child’s

adaptability to

the physical and emotional

environment

Cultures are a means for

sharing knowledge and

skills of a community or

population

The food we eat

The clothes we wear

Our religious beliefs

The way we

celebrate births

The way we

celebrate marriage

The way we

celebrate death

The world

around us

Changing the cultural environment shapes the brains of

the next generation


Developmental stages of brain maturation

Pre birth- 8

months of

age

Birth – 2

years of

age

1- 4 years of age

2 - 6 years

Image source: ©2018 ACF


Brainstem – survival centre

▪ basic life functions

▪ first part of our brain to develop & the most developed brain part at birth

▪ responsible for our heart beat, breathing, sucking and swallowing, temperature control blood pressure and our sleep cycle


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The brain stem under stress and trauma

▪ may experience fast or slower heart rate

▪ shortness of breath or breathing difficulties

▪ sleep disturbances and unsettledness

▪ sucking and swallowing and digestion difficulties

▪ may feel hot or cold or not notice changes in temperature

What do you notice and what can you do?



Cerebellum – body and balance centre

▪ helps us with our posture and balance

▪ helps us with our coordination and to control our movements

▪ helps us to know where our body is in space

▪ helps us with our voluntary movements such as walking and writing



The cerebellum under stress and trauma

▪ lack of coordination and balance

▪ difficulty in maintaining posture

▪ difficulty in undertaking tasks that require balance

▪ lack of awareness of their body in space

▪ difficulty with voluntary movement tasks – walking or writing



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Strategies for transforming – brainstem & cerebellum

▪ include soothing and calming activities, safe containment

▪ movement based activities

▪ include activities that have a rhythmic, repetitive element

▪ include activities that have a balancing element & gross & fine motor skills

▪ breath based activities

▪ conduct a sensory audit – ie: is it too hot or too cold, too noisy?

▪ include proprioceptive and interoceptive awareness and activities

Have PREDICTABILITY in every aspect of the school day and curriculum.

PREDICTABILITY CREATES SAFETY


A Rhythmic Classroom model focuses on building a strong, regulated body – ensuring teachers incorporate knowledge of trauma’s

significant impacts on the body and the body’s regulatory abilities

(Perry, 2009)


A rhythmic classroom or school yard▪ bring rhythm in to the classroom – activities like drumming, music,

physical movement breaks, short exercise bursts

▪ brain breaks or “Brain kits” – for fine and large motor skills – cardio activities, or stationary equipment – (stationary bikes, treadmills)

▪ “rhythmic or containing furniture” for regulation – rocking chairs, hammocks, swings, beanbags, mats, blankets

▪ design school routines with a rhythmic sense to the lesson, day, week and year

▪ embedding “circle” routines and morning meetings with a sense of rhythm, positive emotion, fun and relational attunement

▪ integrating heart rate activities and heart rate monitors in both personal and learning development (ie great to include in maths or science lessons)

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Diencephalon – sorting and sending centre

▪ develops mainly after birth

▪ sorts out “messages” coming into the brain and sends them out to other parts of the brain

▪ uses hormones to send signals to body



The diencephalon under stress and trauma

▪ becomes overwhelmed and cannot sort the information

▪ is unable to send information to the memory and thinking parts of the brain – that pathway shuts down

▪ it alerts the amygdala which sets of a sensory information response sequence




Sensory information response sequence

Image: https://data.integrativepro.com/images/hpa-axis-stress-response.png

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Strategies for transforming – diencephalon

▪ conduct a sensory audit – ie: is it too hot or too cold, too noisy?

▪ provide calm, positive sensory experiences – calming items, fidgets (age appropriate options), boxes or areas in the classroom and other areas

▪ provide regular and predictable brain and body breaks, that include movement, mindfulness or breath-based activities – especially consider transition times

What might help during transitions and at beginnings and ends of classes?



Limbic lobe - emotion and memory centre

▪ helps us attach an emotion to an experience or memory

▪ particularly involved with the emotions

▪ heavily involved in attachment processes

▪ develops mainly after birth

▪ two important brain parts – the amygdala and the hippocampus are in this part of the brain



Amygdala

Has three roles:

▪ Alarm centre - the ‘smoke detector’ of the brain

▪ Memory centre - processes & stores implicit memories

▪ Emotion centre – helps with emotional understanding and regulation

Image source: ©ACF2020

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Implicit and Explicit Memory Systems



The amygdala under stress and trauma

▪ can be over active or under active

▪ can evoke reminders and flashbacks of the trauma (awakenings)

▪ will have difficulty in emotional regulation

▪ will have difficulty in reading facial expressions




Strategies for transforming – Amygdala –IIMPLICIT MEMORIES

▪ understand that their behaviour may be triggered/awakened because of an implicit memory

▪ don’t ask questions at this stage – the thinking part of the brain will be offline.

▪ try to determine what might have caused the triggering or awakening (noise, smell, colour).

▪ stay calm, stay present and with the child or young person. Reassure

Re-entry to the classroom should be a safe and positive transition whenever possible.

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Strategies for transforming – Amygdala -EMOTIONS

▪ include explicit teaching around emotional literacy▪ build emotional regulatory activities in to the day – calming, rhythmic,

repetitive, breath-based – positive and constructive feedback, celebrating significant events, element of joy, fun and laughter

▪ provide opportunities to experience and understand emotions in others –through safe relationships, role modelling and game playing

▪ greet your students at the door or at the start of the day/lesson- even if they are late, make them feel included

▪ take time to know your students, understand their background and acknowledge their learning needs and successes.

(Golding, et al. , 2016)


Hippocampus

▪ explicit memory centre

▪ provides context to memories

▪ provides consolidation of information from short term memory to long term memory

▪ memory puzzle sorting centre



Implicit and Explicit Memory Systems


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The hippocampus under stress and trauma

▪ doesn’t function properly - it feels as if the trauma hasn’t ended.

▪ reduction of hippocampal volume up to 25% as a result of high levels of cortisol

▪ working memory, retention and recall (retrieval) capacity is severely impacted




Strategies for transforming – hippocampus – EXPLICIT MEMORIES

▪ provide lots of opportunities for review of what has been taught

▪ have visual timetables and lots of reminders around the room

▪ reinforce, remind and practice expectations for entering classrooms and routines for classroom learning. Scaffolds like morning routines, timetables, what’s on today, books to be out this morning etc.

▪ use of diaries or other reminder tools for high school aged students

▪ use of sticky notes, colour codes etc to assist

▪ allow extra time for activities

▪ break down tasks to be more manageable


Cerebral cortex – thinking centre

▪ the largest part of the brain

▪ associated with higher brain function such as thought and action

▪ examples of functions:

o reasoning

o logic

o judgement

ovoluntary movement


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The Prefrontal Cortex- executive function centre

Final part of the brain to reach maturity in one’s mid to late twenties

▪ self awareness

▪ reasoning and judgement

▪ foresight and anticipation

▪ focusing and sustaining attention

▪ planning organising and prioritising

▪ decision making

▪ reflecting

▪ enthusiasm, motivation and persistence

▪ impulse control

▪ working memoryImage source: ©2018 ACF


Cortical areas under stress and trauma

Unable to:

▪ use foresight and anticipation, focus or sustain attention

▪ plan, organise or prioritise or make decisions well

▪ reflect or have self-awareness

▪ be enthusiastic, motivated or persist with activities

▪ use impulse controlor




Strategies for transforming – cortical areas

▪ problem solving activities - break down the problem in to “bite size”, achievable goals

▪ mapping and planning out the activity or options

▪ games - card games – boards games – strategy games

▪ voluntary movement activities/complex patterns – table top drumming, clapping etc

▪ thinking and choice games – “Would you rather?”

▪ identity and life story work – help them build a picture of their life

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Medial Pre-frontal Cortex and the Right Orbito-frontal Cortex

Medial



Strategies for transforming – using the medial pre-frontal cortex and the right-orbitofrontal cortex

▪ mindfulness activities – engages the medial prefrontal cortex and the right orbitofrontal cortex

▪ any activities that build on focussing attention, use the working memory, social cognition, attuned communication, involved self-regulation (mirror games), impulse control, and judgement and reasoning.

▪ involve children/young people in physical activities that include movement and build in stillness


Brain food for the developing child

Age Brain function focus Brain food

12-25 years Abstract thinking, decision

making, analysing and problem

solving

Opportunities to practise making decisions, to weigh up consequences,

to take risks in non life and death settings, to learn boundaries.

Integrative activities such as outdoor adventures, ropes courses, group

work, yoga, meditation, mindfulness.

7-12 years Consolidation and Exploration Problem processing opportunities to concentrate on areas of interest, to

challenge and be supported, games requiring skill, strength and agility,

experiences of raised and lowered heart rate.

3 - 6 years Maturing thinking functions Reading, playing games, counting, talking, storytelling, games with

siblings and in teams

1 - 4 years Emotional functions Playing games with parents, dress ups, acting stories, act out feelings,

sharing, taking turns, dress ups

6 months – 2

years

Coordination of body movements Dancing, painting, blocks, threading, sliding, crawling, rolling, running,

clapping

In utero – 9

months

Basic Survival Tactile play, peek a boo, lots of touch, being rocked

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Trauma and the brain

Amygdala

Survival response centre within

the limbic lobe that becomes

enlarged and more sensitive the

more it is activated through

responding to threats

Prefrontal cortex

Responsible for executive

functions, such as

judgement, reasoning, and

self awareness. Final part

of the brain to mature in

one’s mid 20s.

Hippocampus

Consolidates memory by providing the context/

sequential data for episodic memories. Goes offline if

trauma overwhelms and disrupts cortex.

Thalamus

Sensory receptor within the

diencephalon. Receives

and passes on sensory

data to be further

processed by other areas

of the brain

Corpus

Callosum

Bridge between the

2 hemispheres.

Chronic stress can

damage and thin

down this bundle of

neurons

Hypothalamus

Links the nervous system to the endocrine system via the pituitary

gland. It synthesizes and secretes hormones to control body

temperature, hunger, thirst, fatigue, sleep, and circadian cycles.

CerebellumBalance and coordination,

motor skills may be impacted

by trauma



Strategies for transforming

Brain area Function Activity ideas

Brainstem &

Diencephalon

Basic survival &

sensory processing

Pacification or stimulation.

Activities in the child’s preferred sensory modality

Cerebellum Coordination of

movement

Using music, rhyme and movement activities

Limbic Emotional processing Building relational connection through plays,

animals, games

Cortex Thinking processes Linking experiences and sensations to words and

descriptions

Prefrontal cortex Analytical and abstract

thinking

Challenges and safe risk taking activities



Development of the left and right hemispheres

Left Hemisphere

▪ Evaluates

language content

▪ The optimistic

hemisphere

▪ Understands

beginning, middle

and end

▪ Learns from the

past and expects

the future

▪ Looks for patterns

Right Hemisphere

▪ Orientated in the present moment

▪ Eye Contact

▪ Facial Expression

▪ Tone of Voice

▪ Posture

▪ Gesture

▪ Intensity

▪ Grasps the wholeImage source: ©ACF 2020

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Lateral integration – Left and right hemispheres working together

• hemispheric specialisation means that LH and RH need to work together to achieve optimal adaptive states.

• knowing a feeling and giving that feeling a language occur through the integrative capacity of the two hemispheres.

• tuning into, understanding and responding to social cues in communication occur through the integrative capacity of the two hemispheres.


Hemispheres under stress and trauma

▪ will struggle to process the content of our words (left hemisphere -Wernicke’s area )

▪ may not be able to speak & will be acutely aware of our facial expressions, posture, gestures, intensity of movements and eye contact and searching for signs of disapproval, rejection & danger (left hemisphere - Broca’s area)

▪ will be tuned into the tone of voice, not the content (right hemisphere)

▪ difficulties with understanding and knowing feelings and articulating them

▪ difficulties with tuning into, understanding and responding to social cues in communication


Strategies for transforming – RH and LH

Building RH

▪ using attunement and relationally based activities to build connection eg: mutual smiling, mirroring games based on facial expressions, voice copying

▪ modelling appropriate gestures and proximity

Building LH

▪ incorporating cognitive processes into calming or stimulating activities eg: counting for relaxation

▪ providing opportunities to use language and logic – through game playing, discussion and decision making

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Strategies for transforming – building RH/LH connection

Emotionally

▪ attunement and noticing how a child/young person feels, says and shows in the body and giving language – “I notice that you are/have….(tears in your eyes, are yawning lots, are shivering…and I wonder if you are feeling….(sad, tired, scared….)

Physically

▪ doing any activity that enables you to cross the imaginary “midline” of the body eg: cups games, hokey pokey, clapping chants, mirroring games, playing musical instruments, physical activity/sports



Adolescents - The remodelling brain: Pruning & myelination in the teenage brain

https://www.youtube.com/watch?v=jXnyM0ZuKNU


Young people and the importance of sleep

▪ adolescents need more sleep than adults or children - optimal time being about nine and a half hours

▪ pruning and myelination occur during sleep

▪ sleep strengthens learning and memories

▪ later starting times for schools show statistically significant impact on academic achievement

What do you think?Image source: Shutterstock

https://www.youtube.com/watch?v=jXnyM0ZuKNU

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Polyvagal theory and neuroception

Cues of risk and safety are continually monitored by our nervous system.

“Before we can engage in social behaviour and

learning we must first feel safe.”

(Porges, 2015, p.115).

http://lewisinstitute.com.au/wp-content/uploads/2017/08/img-

stragegies2.jpg


Polyvagal Theory and our protective responses

Social Engagement

Soothing and calming

Indicates safety

Behavioural Functions Body Functions

* Lowers or raises vocalization pitch

* Regulates middle ear muscles to perceive human voice

* Changes facial expressivity

* Head turning

* Tears and eyelids

* Slows or speeds heart rate

Mobilization

Fight or Flight

Active Freeze

Moderate to extreme danger

Hyper arousal

* Increases heart rate

* Sweat increases

* Inhibits gastrointestinal function

* Narrowing blood vessels- to slow blood flow to extremities

* Release of adrenaline

Immobilization

Collapse or submission/Death feigning

Increased pain threshold

Conserves metabolic resources

Life threatening situations

Hypoarousal

* Slows heart rate

* Constricts bronchi

* Stimulates gastrointestinal function



Dys-regulated ArousalFreeze Physically immobilized,

frozen, tense musculature

Window

of Tolerance

Fight or Flight Hyper-vigilant, action-

orientated, impulsive, emotionally flooded,

reactive, defensive, self-destructive

Submit Collapsed, weak,

defeated, flat affect, numb, empty,

helpless, hopeless

Sympathetic

Hyper-arousal

Parasympathetic

Hypo-arousal

Ogden, Minton, Pain 2006


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Regulated ArousalFreeze Physically

immobilized, frozen,

tense musculature

Window

of Tolerance

Fight or Flight hyper-vigilant, action-

orientated, impulsive, emotionally flooded,

reactive, defensive, self-destructive

Submit Collapsed, weak,

defeated, flat affect, numb,

empty, helpless, hopeless

Sympathetic

Hyper-arousal

Parasympathetic

Hypo-arousal

Ogden, Minton, Pain 2006

Social Engagement



The trauma organised behaviour cycle

Child/YP is startled by event

or trigger

Child’s/YP’s subcortical, right

hemisphere enacts response

Behaviour provokes a reaction in

others

This reaction is perceived as an

additional threat

Child/YP is in state of heightened

defense– either hyper or hypo

arousal

The lack of explicit,

logical memory, means

the child does not

know what started the

trigger behaviour

Developing brain

imprints the

emotions felt at the

core of the trauma,

as well as the

defence used

against it

Child/YP is still in their

right hemisphere and

so is not using their

cortex to read or

interpret your

response…and is

primed to perceive

ongoing threat

The behaviour pushes

another’s “buttons”

Most likely the

defence state

they used at the

time of the

initial trauma



Arousal

Consider:

▪ What does hyper-arousal look like for students and your centre/school?

▪ What does hypo-arousal look like?

▪ Where is the calm in our centre/school?

▪ What is the calm for us?


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Using the SMART PRACTICE Framework tool

▪ Predictable▪ Responsive ▪ Attuned ▪ Connecting ▪ Translating ▪ Involving ▪ Calming ▪ Engaging


Summary

Trauma has impaired children’s cortical capacity to regulate subcortical functioning. In order to return cortical capacity (which is essential for learning) we must restore calm.

▪ Be predictable

▪ Be connected

▪ Be present

▪ Promote understanding

▪ Equip the child with calming and engaging strategies they can use and help co-regulate



Hope

What are your hopes

for the children/yp

you work with?

What are your hopes

for your school?


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Thank you for your participation!

We appreciate your feedback!



Keeping in touch with ACF & SMART

▪ SMART Online training

▪ SMART training

▪ Discussion papers

▪ Making Space For Learning resources

▪ https://professionals.childhood.org.au/smart-online-training

▪ Prosody Blog http://www.childhoodtrauma.org.au/

▪ Calendar Training https://professionals.childhood.org.au/training-development/course-list/

www.childhood.org.au


References

Australian Childhood Foundation (2010). Making Space for Learning: Trauma informed practice in schools

Baylin, J. & Hughes, D.A. (2016). The neurobiology of attachment-focused therapy. New York: W.W Norton Company.

Bombér, L. M., & Hughes, D. A. (2013). Settling to learn: Settling troubled pupils to learn: Why relationships matter in school. Worth Publishing.

Golding, K., Turner, M., Worrall, H., Cadman, A., & Roberts, J. (2016). Observing Adolescents with Attachment Difficulties in Educational Settings: A Tool for Identifying and Supporting Emotional and Social Difficulties in Young People Aged 11-16. Jessica Kingsley Publishers.

Porges, S. W. (2015). Making the World Safe for our Children: Down-regulating Defence and Up-regulating Social Engagement to ‘Optimise’ the Human Experience. Children Australia, 40(02), 114-123.

Porges, S. (2012). Understanding Polyvagal Theory: Emotion, Attachment and Self-Regulation [Video file]. Psychotherapy Networker. Retrieved July 2, 2016, from Counselling and Therapy in Video: Volume III.

Seigel, D. & Bryson, (2012). T. The whole-brain child. Brunswick: Scribe Publications Pty Ltd

van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin: New York

https://professionals.childhood.org.au/smart-online-training

http://www.childhoodtrauma.org.au/

https://professionals.childhood.org.au/training-development/course-list/

Documents

Understanding and Transforming Trauma SMART 2016€¦ · Strategies for Managing Abuse Related Trauma Understanding and Transforming Trauma SMART Foundation and Strategies 2020 Ceduna